The world has become a global village. With this freedom to share information
comes the ability to travel and relocate. When midwives move from one
country to another, they should, with equivalent education and credentials,
be able to practice their profession wherever they live. However, cultures,
languages, customs, values and attitudes can cause midwifery practices
to vary from one country to another. Prerequisites and the curricula of
midwifery education, as well as the credentialing process, may differ
from place to place.

Yet, we could easily identify the similarities of midwifery learning,
then use that information to compile a list of variations in curricula
and legal requirements in different countries. The midwife who is moving
to another country could look at this list, assess what she needs to know
or do to get licensed, acquire that knowledge, negotiate the licensing
process and be prepared to practice upon arriving at her new home.

For example, the Japanese midwife wishing to practice in the United
States could look at the list of midwifery requirements before she leaves
her country and see what she needs to know in order to practice in the
United States. The Nigerien midwife could move to Europe and prepare to
practice. The Colegio de Matronas de Chile could better evaluate the credentials
of a midwife from Burkina Faso by comparing the countries' requirements
to practice midwifery.

The database for international credentialing could be compiled by utilizing
a simple "needs assessment" questionnaire. Each midwifery credentialing
authority could complete this questionnaire, which would standardize comparisons
between countries. Please note that this proposal makes no suggestion
that any region or country must make provisions for allowing an internationally-trained
midwife to practice, nor does it judge an individual country's requirements.
Each country has unique conditions for midwifery practice; some countries
have two or three licensing boards, others may not have written requirements.
The licensing process is not suggested in this proposal.

The international credentialing questionnaire might include the following
topics:

Selection criteria for entering midwifery training:

Age; educational level; personal, social and legal requirements such
as citizenship, knowledge of the language

Knowledge of the culture:

Language; political issues; alternatives to "traditional" midwifery;
health team relationships; the reputation of the training school (faculty,
content, standards); credibility of evaluating person/institution

Legal credentials:

Licensing; registration; certification required for practice

This questionnaire includes topics that generally are considered necessary
for someone who is beginning her practice; the survey need not be limited
to the above topics.

In addition to the database, a written, international listing detailing
the profession of midwifery could enhance its image. From the information
gathered, all midwifery credentialing authorities and individual midwives
would be able to evaluate their own scope of practice. They would see
what is currently considered "midwifery" by another region.
Midwifery education could be both standardized and flexible, allowing
for the richness of regional differences.

However, the evaluator's credentials are very important when deciding
a midwife's eligibility to practice in another country. Although the criteria
are objective, the subjective judgments of the evaluator are critical.
I suggest that the evaluator be an experienced midwife, with international
experience and education in midwifery educational theory, curriculum and
evaluation.

International credentialing

There are 53 countries represented in the International Confederation
of Midwives (ICM); in addition, seven countries have two or more Member
Associations. Joan Walker, executive secretary of ICM, said the organization
does not have a policy statement on international credentialing, nor does
it have a mechanism for comparing requirements. She believes that the
European Union's Midwifery Directive is the only international, standard
mechanism for easy relocation of midwives.

Since 1983, the European Union has had a legal process called "European
Community Directives for Midwifery" for registered midwives of member
states to gain practice privileges in other member states. The qualified
authority in the home country issues a certificate of eligibility to the
qualified authority with whom the midwife wishes to be recognized.

Maternity Care in the World is a book that lists requirements for midwifery
training by different countries. This book is perhaps the best source
of international midwifery training requirements, and this proposal is
an extension of that information. However, the last edition was published
more than 10 years ago.

I have looked at midwifery course curricula from England, the United
States, India, Nepal, Japan and Australia. At the 1984 ICM convention
in Sydney, I interviewed many midwifery educators about the possibility
of international reciprocity for midwives. Each of them said that reciprocity
would be very desirable, but that administration of the process would
be difficult. However, I confirmed my belief that midwifery core knowledge
is the same internationally. Thus, only the regional differences would
have to be made known and negotiated, in order to become licensed to practice
as a midwife.

In the United States, the nursing profession has a Commission on Graduates
of Foreign Nursing Schools (CGFNS) which "screens and examines foreign
nursing school graduates while they are in their own countries to determine
their probable eligibility for professional practice in the United States."
The standard for eligibility is for a beginning, "first-level"
nurse. CGFNS only facilitates immigration of nurses to the United States.
Currently, there is nothing like this in the United States for midwifery.
The International Confederation of Midwives or the World Health Organization
could facilitate the ongoing compilation of this information. As requirements
change, the information will need to be updated.

Someday, midwifery may control its own destiny as an international profession.
Perhaps the International Confederation of Midwives will provide international
licensure just as the European Union has done for Europe. Until then,
this proposal suggests a first step in the direction of international
credentialing for midwives.

Editor's Note: The author is compiling a list of internationally-trained midwives
who would like to be credentialed to practice midwifery in the United States, and
especially in New York State. If you wish to be part of the Coalition of International
Midwives, send Christine Hindle Verber the following information: your name, address,
phone number, when you came to the United States or when you plan to arrive, type
of midwifery education (what country? when?) and if you have had any training in
the United States (nursing? when? where?). In turn, Christine will share information
about American midwifery and the status of credentialing. She is not charging for
this service, but would appreciate a donation for postage and phone calls. You may
write her at: 49 Eastern Drive, Ardsley, NY 10502, USA, or call (914) 693-9054.

Directives for Midwifery 1983, Office for Official Publications of the European
Communities, Boite Postale 1003, Luxembourg

Maternity Care in the World, Report of a Joint Study Group of the International
Federation of Gynecology and Obstetrics and the International Confederation of Midwives,
(out of print but was available through Worthy Publications, 3 Wykeham Close, Winchester
Road, Bassett, Southampton, Hampshire, England).

Christine Hindle Verber received her doctorate in education from Columbia
University. She is a British nurse and midwife, as well as an American nurse. She
is assistant professor at Lehman College, City University of New York.

Through networking and education, Midwifery Today's mission is to return midwifery care to its rightful position in the family, to make midwifery care the norm throughout the world, and to redefine midwifery as a vital partnership with women.